Wellness Topics for Infants 0 to 2 Years

Breastfeeding FAQs: Getting Started

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common inquiries that mothers — new and veteran — may have.

The major health organizations — including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) — agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months).

When will my milk come in?

During the first few days after the birth of your baby, your body will produce colostrum, a sort of "pre-milk" or "practice milk." For some women, colostrum is thick and yellowish. For others it is thin and watery.

Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that are so important to your baby and aren't found in infant formula. The flow of colostrum is very slow, which allows your baby to learn how to nurse and also how to coordinate sucking, breathing, and swallowing.

After about 3 to 4 days of nursing, your breasts will start to feel less soft and more firm as your milk changes from colostrum to milk that looks kind of like skim milk. Your milk will be transitional for the first 10 to 14 days, after which it's considered to be mature milk.

During this time, the amount of milk your body produces will increase, responding to your baby's nursing. Your milk supply is determined by the stimulation your body receives. In other words, the more you breastfeed, the more milk your body produces.

Mothers who deliver by Caesarean section (C-section) may find it takes longer for their milk supply to increase. Sometimes, for no apparent reason, a mother's milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don't need much more than some colostrum for the first couple days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed more frequently, putting the baby to the breast every 2 to 3 hours.

If your milk still hasn't come in within 72 hours after the birth of your baby, you should talk to your doctor.

Don't be alarmed if your baby drops a little weight at first. Babies should not lose more than 7% of their birth weight, stop losing by the fourth day, begin gaining by the fifth day, and be back to birth weight by no later than the fourteenth day.

When should I begin breastfeeding?

If possible, try to start nursing within an hour after the birth. This timing takes advantage of the wakefulness of your newborn after birth. Many babies will instinctively take to the breast, even their first time. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So, it may be more difficult to get your baby to latch on after the first few hours.

Even if your baby doesn't actually latch on, starting early helps you and your little one to practice and get used to the idea of breastfeeding.

It may take a few times before getting it right, but it's important that your baby latches with a wide-open mouth and takes as much as possible of your areola (the dark-colored area of the breast) in his or her mouth (not just the tip of the nipple). If your baby is sleeping at the breast, try to wake him or her up by tickling the feet or undressing the baby. Frequent attempts to burp and changing the diaper between breasts also can be helpful. Many babies who fall asleep at the breast are not latched on correctly. See your physician or lactation consultant if this continues.

To help both you and your baby get used to breastfeeding, try to feed about every 2-3 hours, even overnight. In many hospitals, you can ask for your baby to "room in" (or stay in the hospital room with you). For moms who want — and need — the extra shut-eye during those first couple of days after the birth, you can have your baby stay in the nursery at night and ask the staff to bring your newborn to you to feed. In many hospitals this is called a "respite nursery." However, if your baby is not rooming in, you won't learn his or her feeding cues, making feeding on demand more challenging when you return home.

Are bottles or pacifiers OK?

If you're committed to trying to exclusively breastfeed, you don't want your baby to suck on a pacifier or a bottle. In the beginning, it's important to allow your baby to practice breastfeeding without being confused by a bottle or a pacifier. Some experts feel that if you start giving bottles too early — before your baby is used to breastfeeding — your little one might have "nipple confusion" and may decide that the bottle is the quicker, better option than the breast. While some babies experience this confusion, others have no problem transitioning between a bottle and the breast.

If a pacifier is occasionally needed in the nursery (such as during a circumcision, when baby boys may be given pacifiers with sugar water), it won't disrupt your nursing.

If the doctor tells you the baby requires a little supplementation with formula, it can be given with a bottle or through a nursing system in which the formula goes through a small tube that attaches to your nipple.

What are the signs that my baby is hungry?

Despite what some new moms might think, crying is a late sign of hunger. You should try to nurse before your baby is so hungry that he or she gets really upset and becomes difficult to calm down.

Signs that babies are hungry include:

moving their heads from side to side

opening their mouths

placing their hands and fists to their mouths

puckering their lips as if to suck

nuzzling again their mothers' breasts

stretching

showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

How can I tell when I'm ready to breastfeed?

During the first few days to weeks after delivery, you may feel strong cramps in your uterus, a sign of the "let-down reflex" that means your milk has come in. Just after you start breastfeeding, you may feel a pins-and-needles or tingling sensation in your breasts, and milk might drip from the breast not being used.

Let-down also can occur if a feeding is overdue or before you start nursing (some women experience let-down from simply seeing their baby or hearing a baby cry). Or, it may happen after your baby is latched on and has sucked a few times (you may notice your baby starting to gulp). Some women have multiple let-downs during a single feeding.

Some women, however, never have a feeling of let-down, which is OK, too. Even if you don't feel it, you should still see milk coming from your nipple and hear your baby swallowing.

How can I tell if my baby is latched on correctly?

This is often the No. 1 reason that new mothers have a hard time with breastfeeding — their babies aren't latched on to their breasts properly, which can be frustrating for the babies and downright painful for their mothers.

Here's how you can make sure your little one is latched on correctly every time:

Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.

Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the circle of skin around the nipple) to latch onto.

Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.

When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible.

Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple.)

Have a nursing session observed by someone knowledgeable about breastfeeding.

When properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into your baby's mouth) then the pain should subside. It will then feel like a tug when your baby is sucking. If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If you still feel pain during feeds even after repositioning, talk to your doctor or lactation consultant to make sure something else isn't going on, such as an infection.

Your baby will often give four to five sucks, followed by a 5- to 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, you can slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong will also frequently sleep at the breast and may not seem satisfied because they may not be getting enough. If either of these occurs, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your doctor or a lactation consultant if:

you're unable to nurse your baby without pain (you may just need help getting your baby to latch on correctly, or it could be a sign of a breast infection)

your baby consistently sleeps at the breast

your baby is nursing but doesn't seem satisfied when feedings are over

your baby does not gain weight appropriately or does not produce the expected numbers of wet and soiled diapers

I'm having a hard time. What can I do?

This is completely normal. Whereas nursing may come easily for some women, it can take some adjustment and practice time for many others. Breastfeeding your baby may be one of the most challenging but rewarding things you'll do as a mother.

While you're in the hospital, don't hesitate to use the expertise of the nursing staff and your OB-GYN. They can be very helpful in answering any questions you might have, as well as walking you through the dos and don'ts of breastfeeding. The nurses can even watch and coach you as you try to breastfeed your baby. The hospital also may have a lactation consultant on staff who may be able to offer some guidance and reassurance.

Doctors usually want to weigh infants and evaluate breastfeeding within 24 to 48 hours after a mother and newborn leave the hospital. But if you have any concerns or difficulties before then, make sure to talk to your doctor.

Whatever you do, try not to become too discouraged. With a little patience and some practice, it will likely become easier for both you and your baby in the coming weeks. Like the old saying goes, practice makes perfect!

Is there more than one way to hold my baby?

Yes. You can experiment with several different nursing positions (or holds) to figure out which one is the most comfortable for both you and your baby.

They include the:

Cradle Hold: This is the traditional hold many mothers will try from the get-go, holding the baby across the chest and using the arm on the same side as the nursing breast to support the baby.

Clutch (or Football) Hold: This position holds the baby at the side, and is good for the mom who's had a C-section (because the baby doesn't put pressure on the mother's belly), as well as for mothers with large breasts or twins.

Cross-Cradle (or Crossover) Hold: Similar to the cradle hold, this position involves using the arm on the opposite side as the nursing breast to support the baby. Some mothers find that this hold makes it easier to control how their babies latch on.

Side-Lying Position: This position, in which mom lies on her side facing the baby, allows moms to get some rest during feedings and is also a common choice for mothers who've had C-sections.

How can I make breastfeeding more comfortable?

Again, it's mostly about finding a comfortable nursing position and proper latch-on — once you've gotten those down, it can make for a truly rewarding bonding experience. Here are some other things you can do that might also help you to relax and enjoy the experience:

Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cell phone (so you don't have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, VCR, or stereo nearby.

Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.

Give your feet and back a break. Footstools and pillows can provide extra support. Pillows that some women find helpful are the wraparound nursing pillows or the "husband" back pillows with arms on each side for nursing in bed.

How long should I plan to breastfeed my baby?

The AAP now recommends that babies be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months, and that breastfeeding continue until 12 months (and beyond) if it's working for both mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding also may protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

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